UPMC Physician Resources

Plant-Derived Anti-Cancer Compounds Explained at National Conference

SAN DIEGO, April 4, 2014 – Compounds derived from plant-based sources — including garlic, broccoli and medicine plants — confer protective effects against breast cancer, explain researchers at the University of Pittsburgh Cancer Institute (UPCI), partner with the UPMC CancerCenter.

In multiple presentations Sunday at the American Association for Cancer Research (AACR) Annual Meeting 2014, UPCI scientists will update the cancer research community on their National Cancer Institute (NCI)-funded findings, including new discoveries about the mechanisms by which the plant-derived compounds work.

“In recent years, we’ve made some very encouraging discoveries indicating that certain plants contain cancer-fighting compounds,” said Shivendra Singh, Ph.D., UPMC Chair in Cancer Prevention Research and professor in Pitt’s Department of Pharmacology & Chemical Biology. “By understanding the molecular mechanisms by which these plant-derived compounds work against breast cancer, we hope to find efficient ways to use them to prevent and fight cancer in patients.”

At the AACR poster session “Mechanisms of Chemoprevention,” Dr. Singh will oversee four presentations by Pitt pharmacology & chemical biology researchers on plant-derived compound discoveries in his laboratory.

  • Dr. Singh will discuss how withaferin A, derived from an Indian medicine plant, binds to tubulin, a well-known target for drug treatment in breast and other cancers. This compound binds tubulin in the cancer at a site distinct from those affected by other clinically used tubulin targeting agents. Notably, this effect of withaferin A is selective for cancerous breast cells.
  • Eun-Ryeong Hahm, Ph.D., will discuss how diallyl trisulfide, an oil-soluble molecule created by chewing of allium vegetables, such as garlic, decreases levels of the estrogen receptor-alpha protein in breast cancer cells and inhibits growth of breast cancer stem cells by decreasing levels of two other proteins.
  • Su-Hyeong Kim, Ph.D., will discuss how benzyl isothiocyanate, a molecule found in edible cruciferous vegetables, such as garden cress, works in breast cancer cells to decrease levels of Bmi-1, a protein that controls genes responsible for cell proliferation.
  • Anuradha Sehrawat, Ph.D., will discuss how breast cancer stem cell growth is inhibited when a protein called Ron sensitizes the stem cells to the benzyl isothiocyanate molecule in cruciferous vegetables. The molecule then induces breast cancer stem cell death.

This work was supported by NCI grants RO1 CA142604-04, P30 CA047904, RO1 CA113363-09 and RO1 CA129347-07.

Recurrent Head and Neck Tumors Have Gene Mutations That Could be Vulnerable to Cancer Drug

SAN DIEGO, April 4, 2014 – An examination of the genetic landscape of head and neck cancers indicates that while metastatic and primary tumor cells share similar mutations, recurrent disease is associated with gene alterations that could be exquisitely sensitive to an existing cancer drug. Researchers from the University of Pittsburgh Cancer Institute (UPCI) and Yale University School of Medicine will share their findings during a mini-symposium Sunday at the American Association for Cancer Research Annual Meeting 2014.

About 50 percent of patients diagnosed with head and neck squamous cell cancers already have disease that has spread, or metastasized, to the lymph nodes, explained Jennifer Grandis, M.D., distinguished professor and vice chair of research, Department of Otolaryngology, Pitt School of Medicine, and director of the Head and Neck Program at UPCI, partner with UPMC CancerCenter. About 20 to 30 percent of patients thought to be cured of the disease go on to develop recurrent cancer, which typically doesn’t respond to standard treatments.

“We decided to compare the genetic signatures of tumor cells from primary tumors with those from disease that had spread and cancers that were thought cured but then came back in the hopes of getting some clues about how best to guide therapy in these different settings,” Dr. Grandis said. “We found that recurrent cancers might have an Achilles’ heel we can exploit to kill them.”

The team conducted the first whole-exome genetic sequencing study on what Dr. Grandis called its “treasure trove” of frozen patient samples and found similar mutations both in primary tumors and in the lymph nodes to which their cancers had already spread. But there were different mutations in tumors that had recurred after a period of remission that were not found in their original cancers.

“The recurrent tumors carried mutations in a gene area that encodes for DDR2 cell receptors,” Dr. Grandis said. “Other studies have shown that DDR2 mutations can confer sensitivity to the cancer drug dasatinib, which could mean that drug has promise in the treatment of recurrent head and neck cancers.”

The researchers suggest that further investigation of dasatinib treatment is warranted.

Disease-Free Survival Estimates for Ovarian Cancer Improve Over Time

SAN DIEGO, April 4, 2014 – The probability of staying disease-free improves dramatically for ovarian cancer patients who already have been disease-free for a period of time, and time elapsed since remission should be taken into account when making follow-up care decisions, according to a study led by researchers at the University of Pittsburgh Cancer Institute (UPCI), a partner with UPMC CancerCenter.

A patient’s prognosis traditionally is determined when they are diagnosed with a disease or when they become disease-free. However, for patients who already have survived or been disease-free for a number of years, these estimates may no longer be accurate because prognosis usually improves over time. Determining a prognosis that takes into account time elapsed since remission may be a more accurate benchmark. This measure is known as conditional disease-free survival.

“Having more accurate information about the risk of recurrence will allow patients and clinicians to make better informed decisions regarding follow-up care after cancer treatment. It also may lead to patients having a better quality of life because a more accurate diagnosis can ease their fears about the cancer coming back,” said Brenda Diergaarde, Ph.D., a UPCI researcher who will present the findings Wednesday at the American Association for Cancer Research (AACR) Annual Meeting 2014.

In the study, researchers estimated disease-free survival and conditional disease-free survival for 404 ovarian cancer patients who had achieved remission and whose information was collected as part of the Hormones and Ovarian Cancer Prediction (HOPE) case-control study. The researchers found disease-free survival estimates for ovarian cancer patients improved dramatically over time, in particular among those with poorer initial prognoses. At time of remission, the probability of staying disease-free for three more years was 48 percent. This increased to 98 percent for patients who had remained disease-free for five years after remission.

Additional contributors to the study were Joel L. Weissfeld, M.D., Janet M. Catov, Ph.D., Marnie Bertolet, Ph.D., Francesmary Modugno, Ph.D., Clareann H. Bunker, Ph.D, and Michelle L. Kurta, Ph.D., all of the Department of Epidemiology, University of Pittsburgh Graduate School of Public Health; Robert P. Edwards, M.D., and Kathleen McDonough, Ph.D., both of the University of Pittsburgh Cancer Institute; Kirsten B. Moysich, Ph.D., Roswell Park Cancer Institute; and Roberta B. Ness, M.D., School of Public Health, University of Texas Health Science Center.

The research was supported by National Institutes of Health grants R01 CA095023, R01 CA126841, P30 CA047904 and R25 CA057703.

Pitt Researchers Find Portable, Low-Cost Optical Imaging Tool Useful in Concussion Evaluation

PITTSBURGH, April 2, 2014 – Two separate projects, spearheaded by University of Pittsburgh Schools of the Health Sciences researchers and published recently in scientific journals, represented important steps toward demonstrating on patients the utility of portable, optical brain imaging for concussion and substantiating — via a large-scale statistical analysis — computerized neurocognitive testing for concussion.

The findings from the optical-imaging research, employing functional near infrared spectroscopy (fNIRS), provided preliminary support for the tool as a low-cost, portable device for imaging sports and military concussions, researchers said. That report, published in Brain Imaging and Behavior, quickly led to further research — a National Institutes of Health-funded study at Pitt examining the brain during dual cognitive-balance performance in children following concussion.

The fNIRS unit works like a pulse oximeter for the brain (video). It measures blood flow to the brain by sending light signals from sensors mounted in a 3-pound headcap, then producing images of blood oxygen changes — representing brain activity — by recording the absorption of light at different colors. The fNIRS produced readouts while participants wearing the bandana-like headcap took a computerized neurocognitive test and matched the test in revealing the brain’s struggles to complete specific cognitive tasks.

“We hypothesize that cerebral blood flow is affected post-injury, and brain processing is going to be less efficient,” explained Anthony Kontos, Ph.D., assistant research director, UPMC Sports Medicine Concussion Program and assistant professor, Pitt Department of Orthopaedic Surgery. “If you’re performing a memory task or reaction-time task, it would require activation — more blood flow, more oxygen needed — in certain areas of the brain specific to that task. However, we found decreased and more spread out activation in the concussed group. In other words, their injured brains were less efficient and strained to get from elsewhere in the brain the resources necessary to perform cognitive tasks.”

“We knew what brain areas normally should light up,” added Theodore Huppert, Ph.D., assistant professor, Magnetic Resonance Research Center, Pitt Department of Radiology and Swanson School of Engineering. “From our data set, we had on average decreased brain activity and more diffuse brain activity — where more areas of the brain were needed to accomplish the task because the usual areas weren’t as efficient.”

This preliminary study included nine people between ages 18 and 45 who were symptomatic within 15 days to 1 ½ months of a sports-related concussion. Researchers compared them to five people who were uninjured. The fNIRS scans indicated that the concussed brain activated at a lower threshold and drew from a wider area — a sharp contrast from earlier functional magnetic resonance imaging (fMRI) studies using concussion patients. And the decrease in oxygenated blood flow and lower test performance were detected during certain, more cognitively strenuous aspects of neurocognitive testing: word memory, design memory and symbol matching.

“It’s a portable and fairly inexpensive imaging device — compared to MRI — and most important, it allows us to combine both spatial and temporal information, meaning what is going on in a specific area of the brain and when the activation is occurring,” Dr. Kontos said. “It’s not just location. It’s not just timing. It’s both.”

A wireless fNIRS device is expected on the market soon, availing it for further research in a clinical and perhaps even a sideline concussion setting said Dr. Huppert, who has worked with and published research on fNIRS for years. Yet Dr. Kontos underscored the utility of the current iteration: “You can wear this while doing neurocognitive testing, you can wear this during balance-testing, you can even wear it while doing exertional testing, like on a treadmill. It’s useable in an environment for sports-related concussion.”

The study was funded by the university’s Department of Radiology. Other co-authors on the study included: Nancy Hill Beluk, B.S., from radiology; R.J. Elbin, Ph.D., formerly of Pitt, assistant professor of kinesiology, University of Arkansas; Scott Dakan, B.S., formerly of Pitt, studying at Ohio State; and Luke Henry, Ph.D., Jonathan French, Psy.D., and director Michael “Micky” Collins, Ph.D., all from the UPMC Sports Medicine Concussion Program.

“In the past decade and a half, many in the field of concussion science have tried to find an imaging tool that could help us in a clinical setting — and failed to find anything with consistency,” Dr. Collins said. “This preliminary study, although small, showed us where in the brain a patient is affected and to what cognitive extent. It was enough evidence for us to keep pushing further with this potential tool.”

The fNIRS study used ImPACT®, a computerized neurocognitive test battery designed to assess mild traumatic brain injury. Dr. Collins is a developer and shareholder of ImPACT Applications, Inc., the maker of ImPACT.

Statistical Analysis Supports Computerized Testing

In a separate study, a meta-analysis published in the March edition of Journal of the International Neuropsychological Society, Rock Braithwaite, Ed.D., professor, Department of Kinesiology and Recreation Administration, Humboldt State University, Arcata, Calif., synthesized all existing research using the four major computerized neurocognitive tests for concussion: Headminder, CogSport, Automated Neuropsychological Assessment Metrics (ANAM) and ImPACT®. In what is considered the largest statistical review of published computerized concussion testing to date, covering 37 studies and 3,960 participants all within the first week of sustaining a concussion, he and his co-authors — who include Pitt’s Dr. Kontos — produced two key findings:

  • Middle-school and younger high-school students displayed more pronounced cognitive effects and greater performance deterioration according to neurocognitive testing after a concussion than their senior high-school and college-aged counterparts.
  • ImPACT® demonstrated the strongest performance for detecting cognitive impairment because it measured the types of tasks that this meta-analysis analyzed as being most effective in detecting such post-concussion issues: processing speed, verbal memory, visual memory and recall.

“ImPACT found the largest effects for individuals who had been concussed, across all outcomes,” said Dr. Braithwaite, who initiated the idea for this study. “Memory, processing speed, recall…ImPACT was able to better detect changes compared to the other computerized tests.”

Dr. Braithwaite said rigorous methods were used to identify concussion studies to be used as part of the meta-analysis.

“This research can help direct future research on concussion,” Dr. Braithwaite added.

Dr. Kontos, a co-author on the meta-analysis along with Drs. Elbin and Dakan, agreed with Dr. Braithwaite that their study is an important first step.

“There is not a lot of good research out there involving many of these tests, and most of the existing research uses the ImPACT test,” said Dr. Kontos, who, like the co-authors on the meta-analysis, has no financial interest in ImPACT Applications, Inc.; Dr. Collins wasn’t involved in this study. “We need more research on the effectiveness of these other tests in patients with sports-related concussion.”

University of Pittsburgh Cardiac Surgery Abstract Accepted for AATS

An abstract submitted by a group of cardiac experts from the University of Pittsburgh School of Medicine has been accepted for presentation at the 94th Annual Meeting of American Association for Thoracic Surgery (AATS) in Toronto, ON, Canada from April 26 to 30, 2014.

The abstract, entitled Extubating in the Operating Room Following Adult Cardiac Surgery Safely Improves Outcomes and Lowers Costs, will be presented during a sessions on Sunday, April 27. Vinay Badhwar, MD, director of the UPMC Center for Mitral Valve Disease and associate professor of surgery in the Department of Cardiothoracic Surgery, was the lead author of the paper.

Co-authors of the paper include Danny Chu, MDLawrence Wei, MD, and Chris Cook, MD, University of Pittsburgh Division of Cardiac Surgery; Regina Hardison, MD, and Maria Brooks, PhD, University of Pittsburgh Department of Epidemiology; Oscar Marroquin, MD, Suresh Mulukutla, MD, University of Pittsburgh Division of Cardiology; Kathirvel Subramaniam, MD, and Stephen Esper, MD, of the University of Pittsburgh Department of Anesthesiology; Abigail Hardt; and Susan Mammarella.

Some Breast Cancer Tumors Hijack Patient Epigenetic Machinery to Evade Drug Therapy

PITTSBURGH, March 26, 2014 – A breast cancer therapy that blocks estrogen synthesis to activate cancer-killing genes sometimes loses its effectiveness because the cancer takes over epigenetic mechanisms, including permanent DNA modifications in the patient’s tumor, once again allowing tumor growth, according to an international team headed by the University of Pittsburgh Cancer Institute (UPCI).

The finding warrants research into adding drugs that could prevent the cancer from hijacking patients’ repressive gene regulatory machinery, which might allow the original therapy to work long enough to eradicate the tumor, the researchers report in their National Institutes of Health-funded study, published in the current issue of Science Translational Medicine.

“Our discovery is particularly notable as we enter the era of personalized medicine,” said senior author Steffi Oesterreich, Ph.D., professor in Pitt’s Department of Pharmacology and Chemical Biology and at UPCI, a partner with UPMC CancerCenter, and director of education at the Women’s Cancer Research Center. “Resistance to hormonal therapy is a major clinical problem in the treatment of most breast cancers. Through testing of a tumor’s genetic and epigenetic make-up, we may be able to identify the patients most likely to develop such resistance and, in the future, create a treatment regimen tailored to giving each patient the best chance of beating their cancer.”

Epigenetic translates to “above genetic” and is an emerging field of study that looks at how environmental factors — such as infections, pollutants, stress and, in this case, long-term exposure to drugs that block estrogen synthesis — could influence a person’s DNA. Epigenetic changes do not alter the structure of the DNA, but they do change the way the DNA is modified, which subsequently determines the potential of gene regulation.

By performing a genome-wide screen in breast cancer cells, Dr. Oesterreich and her colleagues identified a gene called HOXC10 as one that the cancer seems to modify to allow continued tumor growth in patients whose cancer becomes resistant to traditional therapies.

The hormone estrogen represses genes, such as HOXC10, that induce cell death and inhibit growth. About 70 percent of breast cancer tumors are positive for a protein called ‘estrogen receptor alpha,’ which prevents HOXC10 from killing the cancer. To overcome this, doctors put these patients on anti-estrogen therapy, including aromatase inhibitors.

Unfortunately, in some cases, the tumor uses different epigenetic mechanisms, independent of estrogen, to repress the HOXC10 gene. This allows the cancer to continue growing. When the tumor uses these mechanisms, it makes deeper modifications to the expression of the patient’s DNA, permanently blocking the HOXC10 and other genes and making cancer treatment much more difficult.

“In some patients the tumors never respond to aromatase inhibitors and just keep growing. In other patients, using aromatase inhibitors to block estrogen synthesis and allow HOXC10 and other genes to destroy the cancer works in the short term,” said Dr. Oesterreich. “But, eventually, we see the tumor start to gain ground again as the cancer permanently represses genes such as HOXC10. At that point, the aromatase inhibitor is no longer effective.”

Dr. Oesterreich and her colleagues propose that future studies look at offering a combined therapy that, along with aromatase inhibitors, also introduces drugs that modify the epigenome to prevent or delay the cancer from repressing cancer-killing genes.

The researchers also note that more investigation is needed to fully understand all the mechanisms by which HOXC10 mediates cell proliferation and death, and the roles it may play in different types of tumors.

Additional researchers on this study are Thushangi N. Pathiraja, Ph.D., Shiming Jiang, Ph.D., Yuanxin Xi, Ph.D., Jason P. Garee, Ph.D., Dean P. Edwards, Ph.D., Martin J. Shea, Rachel Schiff, Ph.D., and Wei Lei, Ph.D., all of, or formerly of, Baylor College of Medicine; Shweta Nayak, M.D., of Magee-Womens Hospital of UPMC; Adrian V. Lee, Ph.D., Jian Chen, M.S., and Nancy E. Davidson, M.D., all of UPCI; Richard J. Santen, M.D., of the University of Virginia; Frank Gannon, Ph.D., and Sara Kangaspeska, Ph.D., formerly of the European Molecular Biology Laboratory and now at QIMR Berghofer Medical Research Institute in Brisbane, Australia, and at Institute for Molecular Medicine, Helsinki, Finland; Jaroslav Jelinek, M.D., Ph.D., and Jean-Pierre J. Issa, M.D., both of Temple University; Jennifer K. Richer, Ph.D., and Anthony Elias, M.D., both of the University of Colorado; and Marie McIlroy, Ph.D., and Leonie Young, Ph.D., both of the Royal College of Surgeons of Ireland.

This project was funded in part by the Alexander von Humboldt Foundation; U.S. Department of Defense grant 5W81XWH-06-1-0713; National Institutes of Health grants P30CA125123, P30CA47904, P50CA58183, P01CA030195, R01HG007538, R01CA94118 and R01CA097213; Susan G. Komen for the Cure Foundation grant PG12221410; the EIF/Lee Jeans Breast Cancer Research Program; Su2C/Breast Cancer Program; Breast Cancer Research Foundation; and Pennsylvania Department of Health.

Magee-Womens’ Maribeth McLaughlin Named Chair-Elect of American Hospital Association’s Maternal and Child Health Governing Council

PITTSBURGH, March 25, 2014 – Maribeth McLaughlin, chief nursing officer and vice president of patient care services at Magee-Womens Hospital of UPMC, has been named chair-elect of the American Hospital Association’s (AHA) Maternal and Child Health Governing Council. She will assume the role of chair in 2015.

The governing council is comprised of 14 senior executives from the nation’s top women’s and children’s hospitals and health care providers. As a council member, Ms. McLaughlin will advise the AHA on public policy, advocacy and new issues in maternal and child health.

“The AHA leadership position will offer a tremendous opportunity to examine and analyze trends in women’s health across the nation,” said Ms. McLaughlin. “We’ll share experiences with other members on everything from nurturing a healthier workforce – to specific clinical information, such as the elective induction of births.”

“Passion for women’s health is key to this role,” said Leslie Davis, president and chief executive officer of Magee. “Maribeth is incredibly knowledgeable, well-positioned, and clearly viewed as someone to turn to for examples of best practices.”

In addition, Ms. McLaughlin recently assumed the presidency of the Council of Women’s and Infants’ Specialty Hospitals, comprised of 13 non-competing hospitals with high-volume obstetrical care, which collaborate and share information about programs, best practices and national policy.

In her role at Magee, Ms. McLaughlin has been instrumental in promoting interdisciplinary partnerships, developing evidence-based policies and procedures and standards of care, facilitating continuing quality improvement programs and ensuring patient safety and compliance.

Ms. McLaughlin received her nursing degree from Duquesne University and her Master of Public Management from Carnegie Mellon University.

Pitt Study Examines Benefits of Depression Treatment for Heart Failure Patients

PITTSBURGH, March 25, 2014 – Can treating depression in patients with heart failure help them live longer? That’s one of the questions that University of Pittsburgh researchers hope to answer with a new five-year, $7.3 million grant from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH).

Nearly 6 million Americans live with heart failure, according to government estimates, and studies confirm about a quarter of them suffer from depression.

“Evidence-based depression treatments clearly improve health-related quality of life, yet it is presently unknown whether they also reduce morbidity and mortality, particularly in patients with cardiovascular disease. The Hopeful Heart trial will help us find out,” said principal investigator Bruce L. Rollman, M.D., M.P.H., professor of medicine, psychiatry, biomedical informatics and clinical and translational science at the University of Pittsburgh School of Medicine. “Providing mental and physical health care together will allow us to determine whether this approach will not only improve quality of life, but also reduce rates of hospital readmissions, health care costs and mortality above and beyond traditional approaches to heart failure management — which typically neither screens for nor treats co-morbid depression.”

Previous research by Dr. Rollman and his colleagues found that patients hospitalized for heart failure who screened positive with depressive symptoms experienced a 20 percent mortality rate at one year following discharge, compared to just 8 percent among similar heart failure patients who screened negative for depression. After they adjusted for age, gender and other health variables, depression was still associated with a three-fold increase in mortality.

The Hopeful Heart trial will include 750 participants recruited from several UPMC hospitals who meet severity criteria for heart failure and screen positive for depression both in the hospital and at two weeks after discharge over a three-year period. Eligible patients will be randomly assigned to receive either one year of a nurse-provided and telephone-delivered “blended” collaborative care intervention for treating both depression and heart failure, provided in coordination with patients’ cardiologists and primary care physicians; a similar collaborative care intervention that addresses  only their heart failure; or to their doctors’ usual care for these conditions.

“If proven effective and cost-effective, the potentially more powerful and accessible blended care approach for treating heart failure and co-morbid depression could have profound implications for improving chronic illness care and stimulate development of similar interventions for integrating  behavioral health into routine clinical care,” Dr. Rollman said.

Co-investigators of the study include Bea Herbeck Belnap, Ph.D., Kaleab Abebe, Ph.D., Indrani Halder, Ph.D., John M. Jakicic, Ph.D., Jordan F. Karp, M.D., Zachary A. Marcum, Pharm.D., Matthew F. Muldoon, M.D., M.P.H., Ravi Ramani, M.D., Charles F. Reynolds III, M.D., and Kenneth J. Smith, M.D., all of the University of Pittsburgh.

The research is funded by NIH grant R01 HL114016.

Integrating Mental Health Services in Pediatric Practices Feasible, Effective, Pitt Finds

PITTSBURGH, March 24, 2014 – Brief behavioral and mental health programs for children can be effectively provided within pediatric practices as an alternative to being referred to a community specialist, University of Pittsburgh Schools of the Health Sciences researchers found in a National Institutes of Health-funded randomized trial.

Behavioral health treatment provided in the pediatrician’s office resulted in improved access to care, greater participation by both the child and their caregiver in treatment programs, and higher rates of treatment completion, without burdening the pediatric practice, researchers report in the April issue of the journal Pediatrics.

“Treating both physical and behavioral health in the office of the child’s pediatrician is an achievable goal that provides many benefits to the child, caregiver and pediatrician” said lead author David Kolko, Ph.D., professor of psychiatry, psychology, pediatrics, and clinical and translational science in Pitt’s School of Medicine. “When the behavioral health treatment was provided in the pediatrician’s office, participants were more than six times as likely to complete the program, as they were when it was provided at a specialty care clinic outside the pediatrician’s office.”

Dr. Kolko and his colleagues recruited more than 300 children and their caregivers at eight community pediatric practices affiliated with Children’s Hospital of Pittsburgh of UPMC who had been referred for treatment of behavioral problems, though many also had attention-deficit/hyperactivity disorder (ADHD) or anxiety. This study is the third one completed by Services for Kids in Primary-Care (SKIP), a program that integrates behavioral health services into primary pediatric and family medicine practices (more information available at www.skipproject.org).

In this trial, half the children received “doctor office collaborative care,” where a trained behavioral health clinician, known as a care manager, collaborated with the child’s pediatrician to deliver mental health services in the pediatrician’s office. The other half received “enhanced usual care,” where the patients received educational materials and were referred to a local mental health specialist outside the pediatrician’s office who accepted the child’s health insurance.

The participants averaged 8 years old and two-thirds were boys. Most had a primary diagnosis of ADHD, followed by disruptive behavior disorder and anxiety disorder. Only 10 percent previously had received ADHD medication.

In the program at the pediatrician’s office, the child and their caregiver participated in six to 12 individual or family sessions within six months where the mental health clinician worked on individualized goals to address the behavioral health issue and reviewed educational materials to help achieve those goals. The clinician communicated with the pediatrician in regular meetings and through progress notes.

In both the in-office and outside specialist programs, the pediatrician was updated on the patient’s care and could prescribe medication for the child when necessary.

Of the participants assigned to the care manager at the pediatrician’s office, 99.4 percent began treatment programs and 76.6 percent completed them. Of those assigned to a specialist outside the office, 54.2 percent began treatment and 11.6 percent completed it.

The program in the pediatrician’s office also was associated with higher rates of improvement in behavioral and hyperactivity problems, lowered parental stress, better treatment response and consumer satisfaction.

Beyond the child and their caregiver, pediatricians whose offices received the in-office program reported greater efficacy and more confidence in their skills to treat ADHD, compared with the outside specialist program.

“In fact, the participating pediatric practices in this clinical trial later hired their own mental health clinicians to continue delivering on-site services, after the trial had ended,” said Dr. Kolko. “Still more research is needed to understand how pediatric practices adapt clinical and financial strategies to make an in-office behavioral health provider a sustainable resource. Perhaps pediatricians who observe the program in operation may be willing to find a way to support these resources and make that service work.”

Additional co-authors on this study are Stephen Wisniewski, Ph.D., Pitt Graduate School of Public Health; Jonathan Hart, M.S., Western Psychiatric Institute and Clinic of UPMC; Dara Sakolsky, M.D., Pitt School of Medicine; John Campo, M.D., Ohio State University; and Amy Kilbourne, Ph.D., University of Michigan.

This research was supported by NIH’s National Institute of Mental Health grant no. 063272.

Pitt-Led Study Shows Lifestyle Interventions can Prevent Major Depression in Older Black and White Adults with Mild Symptoms

PITTSBURGH, March 20, 2014 – Discussions with a dietary coach to learn about healthy eating were as effective as meeting with a counselor for problem-solving or “talk” therapy in preventing major depression among older black and white adults with mild symptoms of the mood disorder, according to researchers at the University of Pittsburgh and the University of Maryland. Their findings were published online recently in Psychiatric Services.

Depression is common and treatments often don’t completely resolve the disability that attends the illness, said senior author Charles F. Reynolds III, M.D., UPMC Endowed Professor of Geriatric Psychiatry, University of Pittsburgh School of Medicine. Sadness, fatigue and disinterest in activities that used to bring pleasure can leave patients isolated and unable to care for themselves.

“That’s why we’re very interested in finding ways to prevent the disease in those we know are particularly vulnerable,” he said. “Avoiding episodes of major depression can help people stay happy and engaged in their communities, as well as reduce health care costs.”

The team assessed whether problem-solving therapy for primary care (PST-PC), a scientifically proven seven-step approach delivered by non-mental-health professionals to help patients resolve difficulties and thus improve coping skills and confidence, could prevent elderly adults who have mild symptoms of depression from developing full-blown disease. Instead of comparing the PST-PC participants to those who received “usual care,” which would most likely mean receiving no intervention, the team took the novel approach of comparing the PST-PC group to participants who underwent a program of dietary coaching at a similar visit interval for the same number of hours.

Researchers used innovative strategies to recruit and retain African-American study participants, building upon a culturally tailored approach developed by Sandra Quinn, Ph.D., and Stephen Thomas, Ph.D., co-investigators from the University of Maryland Center for Health Equity.

“Because racial minorities are at greater risk for depression, in part due to socioeconomic disadvantages, lower educational attainment and a greater likelihood of other medical problems, we established a foundation of trust working through churches and community-based organizations in black communities,” said Dr. Quinn. Of the 244 participants, 90, or more than a third, were African-American.

“Previous studies we and others have done indicate about 25 percent of people in later life who are mildly depressed become seriously depressed in the next one to two years,” Dr. Reynolds said. The researchers found about 9 percent of the people in each intervention arm went on to experience an episode of major depression, and they all had a similar reduction in depressive symptoms over the two-year study period. Also, both approaches were equally successful among black and white participants.

“This project tells us that interventions in which people actively engage in managing their own life problems, such as financial or health issues, tend to have a positive effect on well-being and a protective effect against the onset of depression.”

“We suspect we had a higher than usual proportion of black participants because community leaders championed the project, no medication was prescribed, and treatment could be delivered at home or at other non-clinical settings,” said Dr. Thomas. “Lifestyle interventions, such as dietary coaching, may be more culturally appropriate and acceptable in racial-ethnic minority communities.”

In a new project, the researchers will examine whether PST-PC can be effectively administered by lay health counselors in low- and middle-income countries such as India.

In addition Drs. Reynolds, Quinn and Thomas, co-authors of the paper include Jennifer Q. Morse, Ph.D., Steven Albert, Ph.D., Mary Amanda Dew, Ph.D., Amy Begley, M.A., Meryl A. Butters, M.D., Jordan F. Karp, M.D., Ariel Gildengers, M.D., Jacqueline A. Stack, M.S.N., John Kasckow, M.D., Ph.D., and Mark D. Miller, M.D., all of the University of Pittsburgh.

The study was funded by the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities and the National Institutes of Health grants MD000207, MH090333, UL1RR024153, and UL1TR000005; the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry; the Commonwealth of Pennsylvania.

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